Home / Conditions / Toe fracture
A broken toe usually comes from stubbing it hard or dropping something heavy on it. Most breaks in the smaller toes heal well with simple care at home. The big toe, and one particular break on the outer edge of the foot, need more attention — which is why it matters which toe it is.
It does. A toe injury can be a bruise, a sprain or a break, and a break in one toe is not the same as a break in another. Where it hurts decides what it needs — and one of these is easily mistaken for a broken little toe.
| Bruised or sprained | Broken little toe second to fifth | Broken big toe | Outer edge of the foot the bone behind the little toe | |
|---|---|---|---|---|
| What you notice | Pain, swelling and bruising — much like a break | Pain, swelling, bruising; sometimes bent | Pain pushing off, hard to walk | Pain on the outer edge, often after rolling the foot |
| What it usually needs | Taping, ice and a stiff shoe | Taping to the next toe, a stiff-soled shoe | A stiff shoe or walking boot; surgery if the joint is involved | A boot or cast; some breaks need surgery |
| Typical healing | One to three weeks | About four to six weeks | About six to eight weeks | Six weeks or longer; some heal slowly |
| Should it be X-rayed? | Often, to be sure | If bent, or not settling | Yes | Yes |
Some toe injuries need seeing the same day: bone showing through the skin, a toe that is cold, pale or numb, or a toe that is badly bent out of line. If you have diabetes or numb feet, even a minor toe injury is worth checking, since it can heal poorly unnoticed. Call the clinic and come in; if we are closed, go to an emergency department.
Each toe is a short chain of small bones — two in the big toe, three in each of the others — joined to a long bone in the foot behind it. The smaller toes carry little weight, so a small misalignment as they heal rarely causes trouble. That is why taping one to its neighbour works so well.
What a picture cannot show is why the big toe is different. It takes a large share of your weight every time you push off, so it has to heal straight. A break that runs into its joint can leave stiffness or arthritis later if it is not looked after.
It also explains the break that is easily mistaken for a broken little toe. The long bone behind the little toe can break at its base, where the blood supply is poor, after the foot is rolled. That kind of break heals slowly and sometimes needs surgery, so it is worth having an X-ray rather than assuming.
Most toe fracture treatment is simple and done without an operation. What it involves depends on which toe is broken, and whether the bone has moved out of place.
The broken toe is taped to the toe beside it, with a little padding between, so its neighbour acts as a splint. A stiff-soled shoe, ice and keeping the foot raised ease the pain. For most broken little toes, this is all that is needed.
A break in the big toe, several broken bones, or a break at the base of the bone behind the little toe usually needs more support. A walking boot or cast keeps it steady while still letting you walk.
If a toe is bent or twisted out of line, it can usually be eased back into place under a local anaesthetic, then taped. Blood collecting under the nail can be released through a tiny hole if it is causing pressure and pain.
An operation is kept for a big-toe break that runs into the joint or is badly out of place, a break through the skin, or one that will not heal. Pins used to hold a bone are often removed after a few weeks; screws may be left in.
Toe fractures here are seen by Dr Jeffrey Tan Gek Meng, a Senior Consultant Orthopaedic Surgeon whose subspecialty is foot and ankle. He is a Fellow of the Royal College of Surgeons of Edinburgh, completed his subspecialty fellowship in foot and ankle surgery at Toronto Western Hospital, and consults in English, Mandarin, Malay, Hokkien and Hainanese.
Often yes, especially with a broken little toe, in a stiff-soled shoe that stops it bending. A broken big toe usually needs more protection, such as a walking boot, and walking may be painful for a while.
It is often impossible to tell by looking — both cause pain, swelling and bruising. An X-ray settles it. It matters most for the big toe and the outer edge of the foot, where a break needs more than taping.
A broken little toe usually heals in about four to six weeks, and a broken big toe in about six to eight. A break at the base of the bone behind the little toe can take longer.
That is a common belief, but it is not quite right. Most broken toes heal with simple care, but a bent toe, a broken big toe, or a break on the outer edge of the foot can leave lasting pain or stiffness if it is not treated properly.
Blood can collect under the nail after a crush or stub. If it is causing pressure and pain, it can be released through a tiny hole in the nail. The nail may later come away and regrow.
No. Bring any X-rays you have, and be ready to say how the injury happened.
Be ready to say how the injury happened. A stub, a heavy object and a rolled foot each point to a different break.
